HM Hospitales

BackgroundChemotherapy-induced thrombocytopenia (CIT) is a common complication of chemotherapy that is associated with bleeding, reduced relative dose intensity, and potentially worse outcomes. No widely available therapies are approved for CIT.MethodsWe conducted a phase 3, international, double-blind, randomized, placebo-controlled trial involving patients with persistent CIT (platelet count, ≤85×109 per liter on trial day 1) who were receiving oxaliplatin-based multiagent cytotoxic chemotherapy for gastrointestinal cancers. Patients were randomly assigned in a 2:1 ratio to receive romiplostim or placebo for three chemotherapy cycles. The primary end point was the absence of CIT-induced modifications of the chemotherapy dose (reduction, delay, omission, or discontinuation) in both the second and third chemotherapy cycles.ResultsOf the 165 patients who underwent randomization (109 in the romiplostim group and 56 in the placebo group), 75% had colorectal cancer, 13% had gastroesophageal cancer, and 12% had pancreatic cancer; 72% of the patients in the romiplostim group and 61% of those in the placebo group had stage 4 disease. The percentage of patients with no CIT-induced modifications of the chemotherapy dose was 84% (92 of 109 patients) with romiplostim and 36% (20 of 56 patients) with placebo, which corresponded to an odds ratio of 10.16 (95% confidence interval [CI], 4.44 to 23.72; P<0.001) and a risk ratio of 2.77 (95% CI, 1.78 to 4.30; P<0.001). Adverse events of grade 3 or higher occurred in 37% of the patients who received romiplostim and in 22% of those who received placebo, which primarily reflected chemotherapy effects. Adverse events that were considered by the investigator to be related to romiplostim or placebo occurred in 12% of patients who received romiplostim and in 7% who received placebo, with the most frequent being nausea (2% in each group) and headache (2% in the romiplostim group); none were serious or led to death or discontinuation of romiplostim, placebo, or chemotherapy. Thromboembolic events occurred in 2% of patients who received romiplostim and in no patients who received placebo.ConclusionsIn this phase 3, placebo-controlled trial, romiplostim was efficacious in treating CIT. (Funded by Amgen and the Biomedical Advanced Research and Development Authority; RECITE ClinicalTrials.gov number, NCT03362177.)

Hodgkin lymphoma is a rare neoplasm of the lymphatic system, representing one of the most common cancers in young adults. It is characterised by a low number of malignant cells derived from B-lymphocytes and an extensive microenvironment. We used Scopus, Web of Science and PubMed databases with search descriptors; “Hodgkin* lymphoma“ and “Hodgkin* disease”. The common bibliometric indicators were applied. We retrieved a total of 18,304 articles within 2002 and 2022. The growth pattern showed a saturated pattern, with the linear and exponential plots coinciding. A small number of authors were responsible for the majority of the publications, with a transience index of 71.84%. The Bradford core consisted of 32 journals, with Leukemia and Lymphoma being at the top. The most productive institutions were resident in United States with the University of Texas MD Anderson Center at the helm. The United States was found to be the most productive country. Engert A. was the most productive author. Scientific production in Hodgkin lymphoma was found to be saturated with a high transience index. This study provides a reference for oncologists, epidemiologists, funders, policy decision makers, academics, and Hodgkin lymphoma researchers.

The data that support the findings of this study are available from the corresponding author upon reasonable request. TABLE S1. Treatment summary TABLE S2. Stereotactic targeting coordinates and quality metrics TABLE S3. Sonication treatment parameters TABLE S4. Thermal dose distribution summary Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Pedicled latissimus dorsi flap (PLDF) and gracilis free flap (GFF) are techniques for restoration of elbow flexion after brachial plexus injuries with late presentation or poor outcomes following nerve surgery, as well as after traumatic or oncological loss of arm flexor muscles. The aim of this study is to compare the results of both techniques. A systematic review was conducted following PRISMA guidelines, including articles providing information on the maximum degrees of elbow flexion or flexion strength according to the MRC scale. Outcomes were synthesized through single-arm meta-analyses using random-effects models, with indirect comparisons between PLDF and GFF performed using Z-tests. Study quality was appraised with MINORS and JBI tools, and publication bias was assessed using funnel plots and Egger's test. Forty-seven studies comprising 814 patients were included: 19 on PLDF (n = 122) and 28 on GFF (n = 692). PLDF achieved a higher mean elbow flexion angle (119.2°; 95% CI 112.5°-125.9°) compared to GFF (91.4°; 95% CI 82.9°-99.9°), a difference that was statistically significant. Likewise, mean muscle strength was greater with PLDF (MRC 3.85; 95% CI 3.61-4.09) than with GFF (MRC 2.95; 95% CI 2.72-3.18). In terms of functional thresholds, 95% of patients in the PLDF group achieved at least MRC ≥ 3 and 87% reached ≥ 4, whereas in the GFF group the corresponding rates were 72% and 65%. Heterogeneity across studies was moderate but consistent with the direction of effect. PLDF was associated with higher pooled flexion angles and strength values than GFF; however, due to the absence of direct comparative studies, these findings should be interpreted as comparative trends rather than evidence of superiority.

Background/Objectives: An increasing proportion of patients with Type 2 diabetes mellitus (T2DM) are classified as high risk, often presenting with multimorbidity, functional vulnerability, and complex treatments. This study compared the sociodemographic, functional, clinical, therapeutic, and healthcare utilization profiles of high-risk chronic patients with and without T2DM in primary health care. Methods: A cross-sectional study included adults classified as high-risk chronic patients in primary health care electronic health records in the Madrid Region (30 April 2021). Sociodemographic, functional, clinical, lifestyle, pharmacological variables, and primary health care services utilization were analyzed. Multivariate logistic regression identified factors independently associated with T2DM. Results: Among 163,188 high-risk chronic patients, 41.5% had T2DM. Patients with T2DM were older, more often male, and had a comparable deprivation index values to non-diabetic patients. They showed higher functional dependency and greater need for informal caregiving. Clinically, patients with T2DM had a higher burden of chronic conditions and a predominance of cardiometabolic, hematological and renal comorbidities, whereas non-diabetic patients exhibited more neuropsychiatric, chronic infectious, oncological and respiratory profiles. Polypharmacy was more frequent in T2DM patients, who also showed lower medication adherence. In the explanatory model, older age (OR 1.02/year), cardiometabolic comorbidities (ORs ~1.2–1.6), highest quartile of morbidity complexity (OR 1.27), polypharmacy (OR 1.34), and concern about medications (OR 1.08) were associated with T2DM, while female sex (OR 0.660), depression (OR 0.888), COPD (0.704), neoplasms (0.688), and higher medication adherence (OR 0.53) were associated with not having T2DM. Conclusions: High-risk chronic patients with T2DM exhibit distinct sociodemographic, functional, and clinical profiles compared with those without T2DM, characterized by greater complexity, cardiometabolic burden, therapeutic intensity and use of healthcare services, supporting the need for tailored, integrated primary health care strategies.

Tyrosine kinase inhibitors (TKIs) discontinuation is the standard option for patients with chronic myeloid leukaemia (CML) in deep molecular response (MR) with imatinib. This study aimed to evaluate the efficacy and safety of one year consolidation with ponatinib on treatment-free remission (TFR) rate. This was a multicenter open-label, single-arm, phase II, exploratory clinical trial including patients with CML treated ≥4 years with imatinib therapy, and MR4.0 ≥12 months. Patients entered the TFR phase after receiving ponatinib at 15 mg/day for one year. Twenty three patients received ponatinib and 19 completed consolidation. Among the patients with detectable BCR::ABL1, 70% deepened response. The 48-weeks MR4.0 rate was 68.4% (95%CI: 43.4-87.4). The 48-week TFR rate as classically defined was 73.7% (95% CI: 8 56.3-96.4). Five restarted TKIs and all regained MR. The most frequent adverse events (AEs) were constipation (34.8%), asthenia (30.4%) and myalgia (21.7%). Patients who remained relapse-free one year after ponatinib discontinuation exhibited higher levels of NK and NKT-like cells with degranulation capacity. Consolidation with ponatinib showed a high TFR rate and adequate safety, granting further research.

This study aimed to investigate global practice patterns, barriers, and physician perspectives on implementing ultra-hypofractionated radiation therapy (UHF-RT) in breast cancer treatment. A 19-question online survey, distributed to radiation oncologists worldwide between February and August 2025, assessed UHF adoption, clinical use, barriers, training, and outlook. Chi-square tests compared adoption by institutional type, economic context, and physician experience (p < 0.05). 89 responses from 24 countries were analyzed. Moderate hypofractionation (MHF) predominated (70.8%), followed by UHF (20.2%). Overall, 80.9% had applied UHF, mainly for breast-only cases. Reported barriers included lack of clinical guidelines (49.2%), insufficient training (20.3%), equipment limitations (18.6%), and reimbursement issues (16.9%). No significant differences in adoption were found, though trends showed higher use in academic centers and high-income countries. UHF is increasingly adopted worldwide, yet MHF remains predominant. Standardizing education, infrastructure, and reimbursement policies could support wider global use.

BackgroundDigital media memes have emerged as influential tools in health communication, particularly during the COVID-19 pandemic. While they offer opportunities for emotional engagement and community resilience, they also act as vectors for health misinformation, contributing to the global infodemic. Despite growing interest in their communicative power, the role of memes in shaping public perception and misinformation diffusion remains underexplored in infodemiology.ObjectiveThis integrative review aims to analyze how memes influence emotional, behavioral, and ideological responses to health crises, and to examine their dual role as both contributors to and potential mitigators of infodemics. The paper also explores strategies for integrating memes into public health campaigns and infodemic management.MethodsA comprehensive literature search was conducted across 3 major databases (MEDLINE, Scopus, and Web of Science), identifying a total of 386 records. Following duplicate removal and eligibility screening, 14 peer-reviewed studies published between 2020 and 2025 were included. An integrative narrative approach was used to synthesize evidence on social media behavior, misinformation dynamics, and digital health campaigns. The analysis was grounded in infodemiological and infoveillance frameworks as established by Eysenbach, incorporating insights from psychology, media studies, and public health.ResultsMemes function as emotionally salient and visually potent carriers of health-related narratives. While they can simplify complex messages and foster adaptive humor during crises, they are also susceptible to distortion, particularly in echo chambers and conspiracy communities. Findings reveal that misinformation-laden memes often leverage humor and disgust to bypass critical thinking, and their viral potential is linked to emotional intensity. However, memes have also been successfully integrated into prebunking strategies, increasing engagement and reducing susceptibility to false claims when culturally tailored. The review identifies key mechanisms that enhance or hinder the infodemiological value of memes, including political orientation, digital literacy, and narrative framing.ConclusionsMemes are a double-edged sword in the context of infodemics. Their integration into infodemic surveillance and digital health campaigns requires a nuanced understanding of their emotional, cultural, and epistemic effects. Public health institutions should incorporate meme analysis into real-time infoveillance systems, apply evidence-based meme formats in prebunking efforts, and foster digital literacy that enables critical meme consumption. Future infodemiology research should further explore the long-term behavioral impacts of memetic misinformation and the scalability of meme-based interventions.

PURPOSEBRUIN CLL-313 is a randomized, open-label, global phase III study comparing the efficacy and safety of pirtobrutinib, a highly selective, noncovalent Bruton tyrosine kinase inhibitor (BTKi), against bendamustine plus rituximab (BendaR), a common frontline chemoimmunotherapy, in treatment-naïve patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).METHODSPatients with previously untreated CLL/SLL without del(17p) were randomly assigned 1:1 to continuous pirtobrutinib monotherapy or BendaR, stratified by immunoglobulin heavy chain gene mutation status and Rai stage. The primary end point was independent review committee (IRC)–assessed progression-free survival (PFS); secondary end points included overall survival (OS), investigator (INV)–assessed PFS, safety, and tolerability.RESULTSOverall, 282 patients were randomly assigned to receive pirtobrutinib (n = 141) or BendaR (n = 141). IRC-assessed PFS was significantly improved with pirtobrutinib versus BendaR (hazard ratio [HR], 0.199 [95% CI, 0.107 to 0.367]; P < .0001), and the 24-month PFS rate was 93.4% (95% CI, 87.6 to 96.5) and 70.7% (95% CI, 61.5 to 78.1), respectively. INV-assessed PFS similarly favored pirtobrutinib (HR, 0.186 [95% CI, 0.093 to 0.371]). Interim analysis of OS favored pirtobrutinib (median follow-up 32 months; HR, 0.257 [95% CI, 0.070 to 0.934]) despite an effective crossover rate of 52.9%. In patients receiving pirtobrutinib versus BendaR: adverse event (AE)–related dose reductions occurred in 3.6% versus 31.1% of patients; grade ≥3 treatment-emergent AEs (TEAEs) occurred in 40.0% versus 67.4% of patients; and treatment discontinuations because of TEAEs occurred in 4.3% versus 15.2% of patients, respectively.CONCLUSIONPirtobrutinib demonstrated superiority over BendaR in IRC-assessed PFS in treatment-naïve CLL/SLL. OS trends favored pirtobrutinib despite the study design allowing for crossover. Pirtobrutinib was well tolerated, consistent with its known safety profile, and more favorable than BendaR.